Provider Demographics
NPI:1396226049
Name:CLEMENTS, DAVID GERALD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GERALD
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GREEN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-2301
Mailing Address - Country:US
Mailing Address - Phone:518-376-1266
Mailing Address - Fax:
Practice Address - Street 1:41 PARK PLZ
Practice Address - Street 2:
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-1520
Practice Address - Country:US
Practice Address - Phone:518-664-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist